Book excerpt: New approaches are needed to monitor and evaluate health and social development. Existing strategies tend to require expensive, time-consuming analytical procedures. The growing emphasis on results-based programming has resulted in evaluation being conducted in order to demonstrate accountability and success, rather than how change takes place, what works and why. The tendency to monitor and evaluate using log frames and their variants closes policy makers’ and practitioners’ eyes to the sometimes unanticipated means by which change takes place. Two recent developments hold the potential to transcend these difficulties and to lead to important changes in the way in which the effects of health and social development programming are understood. First, there is growing interest in ways of monitoring programmes and assessing impact that are more grounded in the realities of practice than many of the ‘results-based’ methods currently utilised. Second, there are calls for the greater use of interpretive and ethnographic methods in programme design, monitoring and evaluation. Responding to these concerns, this book illustrates the potential of interpretative methods to aid understanding and make a difference in real people’s lives. Through a focus on individual and community perspectives, and locally-grounded explanations, the methods explored in this book offer a potentially richer way of assessing the relationships between intent, action and change in health and social development in Africa, Asia, Europe and the Americas.